Anorexie et intersubjectivité : étude phénoménologique et éthologique

RésuméÀ partir du cas de Jeanne, l’objectif de cet article est l’étude des modes d’être-au-monde spécifiques de la personne anorexique. Une approche phénoménologique et éthologique permet de dépasser la symptomatologie strictement alimentaire et médicale en éclairant les dimensions relationnelles et adaptatives essentielles à ce trouble. La véritable structure psychopathologique de la subjectivité anorexique repose, en effet, sur des modes d’interactions spécifiques. Les notions d’altruisme (alimentaire ou non), de corps-pour-autrui, et finalement d’intersubjectivité, mettront en évidence une existence émotionnelle incluant la honte dans le regard de l’autre, et surtout un déséquilibre entre l’autoconservation et l’attention pour autrui. Dans ce contexte, le fameux mécanisme de déni cesse d’être uniquement une caractéristique de l’anorexique, mais est également un processus rencontré tant dans l’entourage que dans l’environnement thérapeutique. Le déni anorexique repose sur l’anosognosie et le refus de constater la maigreur, alors que le déni du monde environnant consiste en une incapacité généralisée de percevoir l’altruisme et la problématique intersubjective sur laquelle repose son existence.

ObjectiveBased on the case study of Jeanne, the objective of this article is to study patterns of anorexic people's specific being-in-the-world. We seek to identify the core vulnerability features of anorexic existence, beyond the dimension of feeding alone. The identification of a psychopathological structure will result in a better understanding of Jeanne's clinical situation and will help to formulate psychotherapeutic and prophylactic recommendations.MethodA phenomenological and ethological approach allows us to see past the strictly medical symptoms (eating disorder). The evolutionary perspective highlights the adaptive dimension of this disorder (e.g., in extreme situations such as famine). Specifically, Demaret's ethological hypothesis identifies altruism (feeding altruism and generalized altruism) as the core feature of anorexic conduct. Phenomenological reflection (phenomenological psychopathology and phenomenological philosophy) appears to complement the ethological approach. Phenomenology distinguishes two kinds of bodies: the Leib (emotional, subjective and experienced in the first person) and the Körper (devitalized, objective and experienced in the second person). Merleau-Ponty's works highlight the difference between the touching body and the touched body. These proposals show the problematic of the other in body configuration. It is in precisely this connection that anorexic existence is specific. Sartre's phenomenology and the lived-body-for-others is the final step of our reasoning to arrive at a configuration of intersubjectivity.ResultsThe analysis of Jeanne's case, combined with ethological and phenomenological perspectives, demonstrates that the real psychopathological structure of anorexic subjectivity rests on specific interaction modes. The notions of altruism, lived-body-for-others, and intersubjectivity highlight an emotional existence including shame in the eyes of others, and especially an imbalance between self-preservation and care for others.ConclusionsAll our thinking suggests that so-called “denial” is a psychological mechanism that should be reconsidered. Denial is not a mechanism of anorexic subjects alone, but is also a process encountered both in the patient's family and in the therapeutic environment. Anorexic denial is based on anosognosia and the refusal to see one's own thinness, while other people's denial constitutes a widespread inability to perceive the altruism and intersubjective problematic on which the existence of an anorexic subject fundamentally depends.